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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 5/3/2019 __ _... �.�... ..._.._............. <br />Department Central <br />Name Adam Parsons Services <br />BPW Date5/14/20,19 Phone Extension 9302 <br />_.m.,.- m._ �... <br />. qu fired Prior to Submittal to Board <br />. ._.... � �...,� ... � �.�.. �� ...� ........ <br />BPW Attorney F-] Attorney Name <br />Dept. Attorney Attorney Name <br />Purchasing 11 <br />Check the Appropriate Item Type -- <br />Q Professional Services Agreement 0 Contract <br />Open Market Contract <br />❑ Amendment/Addendum <br />❑ Bid Opening <br />❑ Bid Award <br />❑ Quote Opening <br />❑ Quote Award <br />❑ Proposal Opening <br />❑ C/O & PCA No. <br />® Chg. Order, No. 1 <br />❑ Traffic Control <br />E] Other: <br />irt?d fibr All Submissions <br />Required Information <br />LJ Proposal <br />E] Special Purchase, QPA <br />E] Req. to Advertise <br />0� Reject Bids/Quotes <br />❑ PCA <br />❑ Resolution <br />Ease./Encroach <br />❑ Title Sheel <br />Company or Vendor Name <br />Premier 1 Construction, Inc. <br />_. <br />New Vendor <br />... w . _........................... —......... <br />E]Yes ❑ If Yes, Approved by Purchasing <br />No <br />MBE/WBE Contractor <br />MBE Completed E-Verify Form Attached ❑❑ N s <br />Project Name <br />Human Rights Commission —Office Re model <br />Project Number <br />_......������ _.._.. .. ....... <br />Funding Source <br />C. .�.._............W............. <br />_ OIT <br />Account No. <br />�._.� .......... .......... w .............. . ...... ,. <br />404-0617-631.36-01 <br />Amount <br />...._..._ ......_._..........w ....... <br />$..._.............._.. ._............. 6 <br />2,877.00 <br />Terms of Contract <br />................. . .............. mw m� ._� � _..._......._-...... <br />Lump Sum ....... ......................w <br />mm,_�.�...... ® ..._... <br />Purpose/Description <br />To extend the installation of carpet to the hallway, replacing wavy, unsafe <br />carpet. <br />For Clay Orders Only <br />Increase _ % <br />Total Percent of Change: Decrease ( % <br />Time Extension Amount: <br />New Completion Date: <br />